Observing white spots on the nipples or the surrounding areola is common. In most cases, these changes relate to normal anatomy or minor, temporary functional changes. White spots generally fall into three categories: benign structures that become noticeable due to hormonal shifts, physical blockages related to milk production, or a dermatological issue.
Normal Anatomy: Identifying Montgomery Tubercles
The most frequent explanation for small, white or flesh-colored bumps is the presence of Montgomery Tubercles. These specialized sebaceous glands are located on the areola and sometimes the nipple itself. They are a normal part of the breast’s anatomy, present in all adults, but hormonal fluctuations often make them more visible.
These glands produce an oily substance that lubricates the skin of the nipple and areola, preventing dryness and cracking. The oil also contains antibacterial compounds, which protect the area and reduce the risk of infection.
Hormonal events like puberty, the menstrual cycle, and pregnancy can cause these tubercles to enlarge and protrude. During pregnancy, they emit a specific scent thought to help guide a newborn to the breast for feeding. The number of these glands varies widely among individuals, ranging from a few to close to 30 per areola.
White Spots Related to Breastfeeding and Blockages
For lactating individuals, a tiny white spot may signify a milk bleb, also known as a milk blister. This occurs when a milk duct becomes clogged at the nipple opening. The blockage is caused either by a plug of thickened, dried milk or by a thin layer of skin growing over the duct, trapping milk beneath the surface.
Milk blebs present as a pinhead-sized white or yellowish spot on the nipple, sometimes resembling a whitehead pimple. They cause localized pain, often described as a sharp, stinging sensation, particularly during nursing or pumping. Causes often relate to an ineffective latch, which applies uneven pressure, or tight clothing that restricts milk flow.
Home care involves applying a warm compress to the nipple before feeding or pumping to soften the area. Gently massaging the breast while nursing can assist in dislodging the blockage and promoting drainage. Applying a small amount of olive oil on a cotton ball can also help soften the skin over the pore, encouraging the blockage to clear.
Dermatological Causes and When to Consult a Doctor
Beyond normal anatomy and functional blockages, white spots can be linked to dermatological conditions. Nipple thrush is a fungal infection caused by an overgrowth of Candida yeast, which thrives in warm, moist environments. This infection presents with white patches or a shiny appearance on the nipple and areola, often accompanied by intense burning or deep pain.
Contact dermatitis or eczema is another possibility, causing the skin to become dry, flaky, and appear white or scaly. This is typically an irritant reaction to soaps, laundry detergents, or fabrics. While treatable with topical medications or by removing the irritant, any persistent or unusual skin change warrants medical evaluation.
Consulting a healthcare provider is necessary if the white spot is accompanied by warning signs. These include persistent, unexplained pain or tenderness that does not resolve with simple care. Other concerning symptoms are bloody or discolored nipple discharge, a palpable lump in the breast, or changes to the skin texture like thickening or ulceration. A persistent, scaly rash on the nipple and areola that resembles eczema but does not heal may indicate a serious condition, such as Paget’s disease.